# Value-Based Programs Lead

**Company**: Humana Inc.
**Location**: Remote Nationwide
**Work arrangement**: remote
**Experience**: senior
**Job type**: full-time
**Salary**: $104,000 - $143,000 per year
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://humana.wd5.myworkdayjobs.com/en-US/Humana_External_Career_Site/job/Remote-Nationwide/Value-Based-Programs-Lead--Medicaid-_R-429097?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_27e90f34-1a2

## Description

Humana Healthy Horizons is seeking a Value-Based Programs Lead to support successful value-based provider relationships, focusing on improving the provider experience and achieving path-to-value goals.

The Value-Based Programs Lead will lead the end-to-end operational support of specialty Medicaid value-based payment (VBP) models, aligning with segment strategy and goals. This role requires advanced technical knowledge and experience in VBP.

Key responsibilities:

- Develop innovative VBP models for various provider types, such as behavioral health, maternity, specialists, and social determinants of health.

- Align scope of work with roadmap for new VBP model development to ensure compliance with Medicaid contractual requirements and RFP commitments.

- Analyze financial, utilization, and performance data to identify opportunities for improvement.

- Create VBP payment strategies and model design, including payment model logic, performance metrics, and benchmarks.

- Design and contribute to development of provider reporting packages.

- Partner with finance team to conduct impact analysis and modeling for new VBP models.

- Collaborate with team members and matrixed teams to operationalize and rollout new VBP models.

- Monitor VBP model performance KPIs to identify opportunities for enhancement.

Requirements:

- Bachelor's degree.

- Minimum 5 years of experience in managed care operations, provider reimbursement and analytics, and value-based care.

- Expertise in VBP model design and strategy with specialty providers.

- Expertise in Medicare and/or Medicaid managed care.

- Ability to understand and analyze financial, utilization, and performance data.

- Excellent interpersonal, organizational, written, and oral communication skills.

Preferred qualifications:

- Master's degree.

- Expertise in VBP financial modeling and impact analysis.

Additional information:

- Remote position.

- Up to 10% travel for onsite meetings.

- Typical workdays and hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).

Benefits:

- Competitive benefits supporting whole-person well-being, including medical, dental, and vision benefits, 401(k) retirement savings plan, time off, and more.

## Skills

### Required
- value-based care
- managed care operations
- provider reimbursement
- analytics
- VBP model design
- Medicaid managed care
- Medicare managed care
- financial analysis
- performance metrics
- benchmarks

### Nice to have
- VBP financial modeling
- impact analysis

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Source: [Apply at humana.wd5.myworkdayjobs.com](https://humana.wd5.myworkdayjobs.com/en-US/Humana_External_Career_Site/job/Remote-Nationwide/Value-Based-Programs-Lead--Medicaid-_R-429097?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)